AJCC ECE 2020-21 Gan Hamaish (Kindergarten) Program Application

Child’s Name *

Birthdate *//

Parent/Guardian Names *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Phone #2

Email *

Email #2

Do you have an active AJCC Family Membership? AJCC Family Membership will be require before enrollment. *

YES
NO

Please select the schedule you are interested in *

3-Day (Mon, Wed, Fri) 9:00am-2:30pm $228 a week / $910 a month / $9,100 a year
5-Day (Monday-Friday) 9:00am-2:30pm $313 a week / $1,252 a month / $12,520 a year

The ECE will offer winter play days December 21st - 31st, 9:00am-2:30pm (ECE is closed December 25th & January 1st). Please select the days you would like your child to attend. Play days will be billed in the month of service.

Monday, December 21 / $70 a day
Tuesday, December 22 / $70 a day
Wednesday, December 23 / $70 a day
Thursday, December 24 / $70 a day
Monday, December 28 / $70 a day
Tuesday, December 29 / $70 a day
Wednesday, December 30 / $70 a day
Thursday, December 31 / $70 a day

The ECE will offer winter play days December 21st - 31st, 9:00am-2:30pm (ECE is closed December 25th & January 1st). Please select the days you would like your child to attend. Play days will be billed in the month of service.

Monday, December 21 / $70 a day
Wednesday, December 23 / $70 a day
Monday, December 28 / $70 a day
Wednesday, December 30 / $70 a day

The ECE will offer spring play days April 5th-9th, 9:00am-2:30pm. Play days will be billed in the month of service.

Monday, April 5 / $70 day
Wednesday, April 7 / $70 a day
Friday, April 9 / $70 a day

I agree to a non-refundable and non-transferable registration fee of $275 that will be processed at the time of registration. Please note: if you paid a summer 2020 registration fee this amount will be discounted to $175. *

I AGREE

Total (There will be a total of 10 payments processed on the 17th of each month starting with August 17th)

$ 0.00

How would you like to pay? *

Credit Card
EFT (attach voided check)
Payroll deduction (AJCC STAFF ONLY)

If you have a change of payment information please contact Rachel Gordon at rgordon@alpertjcc.org

Name on Credit Card: *

Last 4 digits for card on file *

Exp. *

Upload image of a voided check below *

Click or drag a file to this area to upload.

I would like to contribute a one-time additional donation to help a child attend the ECE in the amount of....

Please list individuals authorized to pick up your child (include first and last name and relationship).

Please list any allergies your child has below.

Does your child receive additional services (such as physical therapy, occupational therapy, speech therapy).

YES
NO

By signing this form, I agree to the following conditions:

Registration fee is non-refundable and non-transferable. *

Please enroll my child as indicated by the above selections. *

Proof of immunization is necessary for my child to start the program and must be updated annually. Children's immunization records must be turned in within the first 30 days of your child beginning the program. *

Upload immunization records below

Click or drag a file to this area to upload.

Alpert JCC membership dues must be current throughout the time for which the child is registered. *

I understand I have 48 hrs after confirmation of enrollment to withdraw without penalty. After this period, I understand that 30 day notice is required for withdrawal and there will be a minimum of one (1) month penalty fee. *

There will be a $50 charge for failed or returned payments *

We reserve the right to withhold services. The applicant agrees to abide by all rules and regulations of the Alpert JCC and I understand that failure to act in accordance with the rules may result in expulsion from the Alpert ECE with no refund. *

Tuition payment is required regardless of absence including, but not limited to, vacation, illness or unforeseen closure. *

Should families wish to withdraw from the program at any time during the year, our usual withdrawal policy will apply. Should we be ordered to close by city, county, state, or federal officials at any time, families will be required to meet their financial commitment for the duration of that calendar month so that we can continue to compensate teachers through the end of the month. After that time, no further charges will be made until we re-open. (For example, suppose we were ordered to close from December 12 through February 10. Families would be required to pay their tuition through December 31, and teachers would be compensated through December 31. There would be no charges for the month of January, and charges for February would be pro-rated.) If we are required to close for a short period of time, 48 to 72 hours, in the event of a positive case of COVID-19 in our community, there will be no refunds granted. *

I understand that I am responsible for tuition payments outlined in this contract and that I am responsible for providing the Alpert JCC with updated payment information if necessary. I understand that if any past due payments are not paid within 48 hours of notification services will be suspended or terminated. *

I understand that late charges will be charged as incurred at $1 a minute for every minute late. Charges will be processed automatically with the card on file the next business day. *

Participation in AJCC activities constitutes permission for the agency to use any photos or videos of the participants for promotional purposes, without remuneration.

Please do NOT use my child's photo for any promotional purposes.

Please do NOT use my child's photo for any promotional purposes.

Morning/Afternoon snack & lunches will be brought from home and follow healthy food and licensing guidelines. No food will be provided on site. *

Food Sensitivities/Allergies

I understand that the ECE has a pre-approved list of options with an outside vendor for classroom birthday celebrations. I understand that only the pre-approved options and vendor can be used for classroom celebrations. *

Due to food sensitivities/allergies, the ECE maintains a nut-free policy and no nuts of any kind will be permitted within the ECE *

I understand that the ECE can change the food policy at any time based on need. *

Coronavirus / COVID-19 Warning & Disclaimer: Coronavirus a/k/a COVID-19 is an extremely contagious virus that spreads easily through person-to-person or other contact. Federal and state authorities recommend social distancing as a means to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in programs or activities upon the AJCC ECE premises could increase the risk of contracting COVID-19. The AJCC ECE in no way warrants that COVID-19 infection will not occur through participation in programs or activities upon the AJCC ECE premises. I hereby certify that I have full knowledge of the nature and extent of the risks inherent in my and my child’s entry upon the AJCC ECE premises, the use of any of the AJCC ECE’s facilities or equipment, and my child’s participation in any of the AJCC ECE’s programs and that I am voluntarily assuming said risks. I understand that I will be solely responsible for any loss or damage, including personal injury, property damage, or death, I sustain as a result of my entry upon the AJCC ECE premises, the use of any of the AJCC ECE’s facilities or equipment, and/or my participation in any of the AJCC ECE’s programs and that by signing this agreement I HEREBY RELEASE THE AJCC ECE from all liability for such loss, damage, or death. I further certify that my child is in in good health and has no conditions or impairments which would preclude their safe entry upon the AJCC ECE premises, the use of any of the AJCC ECE’s facilities or equipment, and/or their participation in any of the AJCC ECE’s programs. *

By signing below I understand and agree that I am financially responsible for payment. I understand that delinquent payments not paid within 48 hours of notification will result in suspension or termination of services. *

Parent/Guardian Signature

Date *//

Parent/Guardian Signature

Date//

Students must be 5 years old at the time of enrollment.

★ This is a 10-month program beginning August 31st, 2020, and ending June 3rd, 2021. For questions regarding this please contact Emily Gould, ECE Director at egould@alpertjcc.org ★

Please Note: This application does not confirm acceptance.

By signing this form, I agree to the following conditions:

Food Sensitivities/Allergies

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